Developing the pathology workforce Professor Sue Hill Chief Scientific Officer Department of Health

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Developing the pathologyworkforce Professor
Sue HillChief Scientific OfficerDepartment of
Health

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CONTEXT- NHS PLAN 1999 and NHS Improvement Plan
2004

• Radical reform and modernisation of health and
  social care system
• Based around delivery of improved services and
  access to healthcare for Patients and the Public
• Delivered by an expanded workforce, working in
  new ways
• Recognition that scientists and other members of
  the healthcare team would develop professional
  roles

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More staff, working differently

• Continuing increases in frontline NHS staff where
  required to meet patients needs
• Staff supported in working differently, making
  best use of skills (introduction of health care
  scientists with special interests to enable care
  to be delivered flexibly)
• Potential fulfilled with skills escalator helping
  staff develop areas appropriate by modernised
  education and training, more flexible working
  approaches and based on transferable competing
  based modules
• Pay linked to performance
• NHS Improvement Plan, June 2004

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Drivers for Change
Workload
Policy etc
Pathology
Tradition
Finance
Staffing
Technology
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Pathology Modernisation

• Focus for ensuring pathology services can respond
  to future challenges (eg. science and technology,
  changing clinical practice, changing public
  perception and expectation)
• Implementation supported by 9.1 million revenue
  and 54 million capital investment
• Phlebotomy recognised as function provided by
  pathology departments
• Modernising Pathology Services (February 2004)
  www.dh.gov.uk/pathologymodernisation

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D I A G N O S T I C S
Equipment Infrastructure
Reconfiguration/ Modernisation of Services
Workforce
Changing Practices
Systems Process Redesign
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HCS and Diagnostics workstreams
Healthcare Scientists

• Key to all 4 Workstreams
• Complex workforce - 50 Disciplines, 6
  Employment Groups
• Contribution not always recognised
• Workforce planning/Data collection difficult
  Skills often under utilised
• Many opportunities whole system approach
• Mostly secondary care based

Pathology
Physiological Measurement
Imaging
Endoscopy
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Diagnostic test components
EQUIPMENT DIAGNOSTIC TEST Simple Routine
Specialist Complex RESULTS INTERPETATION
REPORTING CLINICAL ADVICE

• Preparation (can include environments
• Calibration/verification and QA
• Maintenance/repair
• Operating safety ( impact on environments)
• Contraindications
• Protocols/standards
• Patient specific modifications
• Technical acceptability
• QA of test performance/procedure
• Technical acceptability (limitations)
• Selection of result
• Linked to presenting symptoms/provisional
  diagnosis
• Pattern Recognition (sophistication?)
• Comparison with internal QA within sets of
  results
• Support Differential Diagnosis
• Treatment options and Further Investigations

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Requirements of Pathology services

• Multidisciplinary approach
• Partnership
• Dismantling professional barriers
• Changing the workforce
• Focusing on outputs
• Effective performance monitoring
• Appropriate use of services

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HCS Workforce initiatives

• 9 stage integrated Career Pathway linked to
  Agenda for Change
• NOS HCS competency framework, supported by
  Education Training, and Award and
  Qualification frameworks
• HCSwSI and promotion of best practice
• CWP HCS Spread programme
• Lead SHA WDs for workforce planning and
  development, WRT HCS focus, LDP returns, HCS
  census, Training pilots
• NWW at medical/scientific interface with Medical
  Royal colleges
• Profile and Awareness raising

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DOH Welsh PSAG
Assembly
UK Wide Project 1.6 Million SEMTA SSC
Project Management
NOS PROJECT HEALTHCARE SCIENCE STEERING COMMITTEE
Wide Representation from Key Stakeholders
Strategic Direction Policy Decision
MANAGEMENT COMMITTEE
Reporting responsibilities within DH
NOS DEVELOPMENT
ASSESSMENT linked to AWARDS QUALIFICATION
framework
EDUCATION TRAINING framework
IMPLEMENTATION strategy
PROFESSIONAL BODIES PRACTITIONERS AND OTHER KEY
STAKEHOLDERS
PILOT SITES IN TRUSTS THROUGHOUT UK
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The NOS HCS Framework

• represents best practice statements based on the
  functions delivered within the occupational area
  ( eg clinical biochemistry)
• delivered through work-based and competence-based
  programmes
• used to develop vocational qualifications and
  awards
• support wider entry gates to professional
  education and training and increase diversity in
  the workforce

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Scope of HCS NOS Project
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STANDARDS DEVELOPMENT PROCESS
WORKING GROUPS OF EXPERTS COVERING ALL LEVELS OF
PRACTICE
- Discipline specific - Common - Generic
Identification of key purpose/functions
Functional breakdown of key purpose/functions
Development of performance criteria
Identification of essential underpinning
knowledge
- broad brush statements - indepth database
- What has to be done - How well - What range
PRODUCTION OF OCCUPATIONAL STANDARDS
Field Testing Revision Piloting
Development of assessment strategy
COMPETENCY FRAMEWORK
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Generic functions across sector
Function A Develop maintain equipment
devices Function B Perform investigative,
therapeutic rehabilitation procedures Functio
n C Obtain analyse biological other
specimens Function D Report, interpret provide
clinical advice Function E Promote, develop
maintain health and safety Function F Direct
manage services, developments
resources Function G Education, training
development Function H Research and
development Function I Supporting and assisting
patients and individuals
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Functional NOS Example
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• Disciplines included
• - Anatomical pathology
• - Blood transfusion
• - Clinical biochemistry Toxicology
• - Clinical cytogenetics
• - Clinical embryology
• - Clinical immunology
• - Cytopathology incuding cervical cytology
• - Electron microscopy
• - External Quality Assurance
• - Haematology
• - Haemostasis and thrombosis
• - Histocompatibility and immunogenetics
• - Histopathology
• - Molecular genetics
• - Microbiology
• Phlebotomy
• Tissue Banking

ENGINEERING PHYSICAL SCIENCES
LIFE SCIENCES GENETICS
PHYSIOLOGICAL SCIENCES
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CLINICAL BIOCHEMISTRY Deliver clinical
biochemistry services for the prevention,
diagnosis and management of disease
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Functional NOS Example Clinical Biochemistry
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Cervical Cytology
Key purpose Contribute to reduction in the
incidence of and mortality from cervical cancer
through the provision of cervical cytology
laboratory services
Verify patient identification details prior to
examination of cervical sample
Judge Cervical Samples to recommend further
action in respect of cervical screening
Maintain records for audit and reporting
Prepare slides for microscopy
Primary screen slides to evaluate sample
Rapid review negative and inadequate slides to
verify primary screening judgement
Check abnormal and equivocal slides for presence
of abnormal cells
Monitor information system to ensure follow up
action is taken
Recommend management of abnormal results of
cervical screening
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Complete NOS Framework ( 900 standards)
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National Occupational Standards NOS
Knowledge and Skills
Performance criteria and range
Framework for design of training and development
Framework for assessment of performance at work
Training Manual
Work Objectives
Syllabus Learning Specification
Workplace Assessment Actual workplace performance
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Using a NOS FrameworkAssessing Work Performance
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Assessment requirements

• Robust work based assessment for both initial
  assessment of competence (across career pathway)
  and ongoing maintenance
• Linked to overarching award and qualification
  structure (being developed in conjunction with
  NHSU)
• Key role for professional bodies in achievement
  of national standards

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A Career Framework for the NHS
MORE SENIOR STAFF Staff with the ultimate
responsibility for clinical caseload
decision-making and full on-call accountability.
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CONSULTANT PRACTITIONERS Staff working at a very
high level of clinical expertise and/or have
responsibility for the planning of services.
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ADVANCED PRACTITIONERS Experienced clinical
professionals who have developed their skills and
theoretical knowledge to a very high standard.
They are empowered to make high-level clinical
decisions and will often have their own caseload.
Non-clinical staff at level 7 will typically be
managing a number of service areas.
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SENIOR PRACTITIONERS / SPECIALIST
PRACTITIONERS Staff who would have a higher
degree of autonomy and responsibility than
Practitioners in the clinical environment, or
who would be managing one or more service areas
in the non-clinical environment.
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SKILLS AND COMPETENCIES
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PRACTITIONERS Most frequently regsitered
practitioners in their first and second
post-registration / professional qualification
jobs.
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LEARNING AND DEVELOPMENT
ASSISTANT PRACTITIONERS / ASSOCIATE
PRACTITIONERS Probably studying for foundation
degree or BTEC HND. Some of their remit will
involve them in delivering protocol-based
clinical care that had previously been in the
remit of registered professionals, under the
direction and supervision of a state registered
practitioner.
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SENIOR HEALTHCARE ASSISTANTS / TECHNICIANS Have a
higher level of responsibility than support
worker, probably studying for of have attained
NVQ Level 3, or Assessment of Prior Experiential
Learning (APEL)
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SUPPORT WORKERS Frequently with the job title of
Healthcare Assistant/technician - probably
studying for of have attained NVQ Level 2.
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INITIAL ENTRY LEVEL JOBS Jobs such as Domestics
or cadets requiring very little formal
education or previous knowledge, skills or
experience in delivering, or supporting the
delivery of healthcare.
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Healthcare Scientist Career Pathway
Consultant Director 9
Consultant Practitioner 8
Advanced Practitioner 7
Specialist Practitioner 6
Practitioner 5
Associate Practitioner 4
Senior Assistant 3
Assistant 1-2
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Healthcare Scientist Career Pathway
Multi-point Entry Routes linked to education,
training, competence
Consultant Director 9
Consultant Practitioner 8
Advanced Practitioner 7
Specialist Practitioner 6
Practitioner 5
Associate Practitioner 4
Senior Assistant 3
Assistant 1-2
Three points of regulation with HPC
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Healthcare Scientist Career Pathway
Linked to Functional Framework Knowledge,
training, expertise Analytical, physical,
clinical skills Financial, physical human
resources Planning, policy, service
development Autonomy/freedom to act Research and
development Patient care and public health
Consultant Director 9
Consultant Practitioner 8
Advanced Practitioner 7
Specialist Practitioner 6
Practitioner 5
Associate Practitioner 4

• Benchmarked against
• National Occupational Standards
• Agenda for Change
• Generic Job Profiles
• KSF Dimensions

Senior Assistant 3
Assistant 1-2
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Career Pathway Stage (Discipline)
NOS Framework
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HCS Competency Framework
Associate Practitioner
Registered Practitioner
Specialist Practitioner
Advanced Practitioner
1 2 3 4
Consultant
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Career Pathway Stages - NOS
Roles
Development Modules
Role 1 (title) Discipline Specific NOS 1 NOS
3 Related Disciplines NOS 27 Common/Generic NOS
A2 NOS B4
Module 1 ___________________ Module 2
___________________ Module 3 ___________________ M
odule 4 ___________________ Module 5
___________________ Module 6 ___________________

Role 2 (title) Discipline Specific NOS 3 NOS
6 Related Disciplines NOS 45 Common/Generic NOS
A2 NOS D2 NOS E1
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HEALTHCARE SCIENTISTS CAREER PATHWAY
Level Learning
8/9 Consultant Management/Leadership programmes

Workload and Roles
R e g u l a t i o n
7 Advanced Professional Examinations/Vocational
Awards Higher Degrees
6 Senior or Specialist Postgraduate
Qualifications Professional Examinations/Vocati
onal Awards
Careers
5 Basic Qualified Vocational Degrees/Diplomas/Aw
ards
4 Associate Foundation Degrees /
Certificates NVQ based awards
3 Senior Assistant National Certificates / NVQ
based awards
1 / 2 Assistant Work Orientation NVQ Award /
Access Courses
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Career / QualificationFramework /
SkillsEscalator Model
Vocational
Academic
Underpinning Competence Framework
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HCS Competence Assessment
Generic Common NOS
Individual Role/Job
AfC KSF
Profile for Grade /Role
Discipline Specific NOS
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Competence Development
Cancer, CHD, Emergency Care (Access), Mental
Health, Long Term Conditions
Children / Older People
HCS
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Changing primary secondary care landscape
Medical Technology Communications
Technology Public Expectation
Science Governance Working Times
COMMUNITY-BASED, HOME-BASED AND SELF CARE
REGIONAL SUB-REGIONAL CENTRES
Technology links Shared teams

• Improving access and choice
• Improving services and outcomes
• Improving overall experience of patients
• Reducing health inequalities
• Bringing together Health and Social Care

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Achieving Patient centered care
Primary care
Secondary care
Self care
Primary care
Patient
Secondary care
Intermediate care
Patient
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Models of HCS Service Provision
PRIMARY CARE
Technology links Shared teams
SECONDARY CARE
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Clinical Biochemistry Staff Teams
Within Lab Ex-Lab
Within Lab Ex-Lab
Assistant
HCS 1-9
BMS 1-4
CS A-C
Medic
Medic
Present Future
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Evolution Examples of New Roles/Services

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Extended / New HCS Roles

• HCS-4 Former MLA working as reception
  supervisor
• HCS-4 Former MLA performing core analysis
  under supervision
• HCS-6 Former BMS-1 reporting results with
  interpretive comments
• HCS-7 Former BMS-2 working as outreach
  co-ordinator of POCT in primary care centres
• HCS-7 Former BMS-3 working as Directorate HCS
  training officer
• HCS-8 Former CSB working as RR director for
  an NHS Trust

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Facilitates Flexible Careers and New Ways of
working
Underpinned by qualifications and competence
assessment Locally driven requirements
Consultant Director 9
Consultant Practitioner 8
Advanced Practitioner 7
Specialist Practitioner 6
Practitioner 5
Associate Practitioner 4
Senior Assistant 3
Assistant 1-2
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Healthcare Scientist Profile 2009?
Assistants Associates
Specialists Consultants
n
1-2 3 4 5 6 7 8 9
Healthcare Scientist Career Pathway
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Healthcare Science crosses many pathways
HCS DEPARTMENTAL BOUNDARIES
A B C D
E
Emergency and Elective Care
Cancer, CHD, other NSFs, priorities
Diagnostics, Chronic Disease
Important to ensure HCSs are engaged in service
and workforce planning arrangements ( eg LDPs,
Census returns)
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DIAGNOSTIC TESTSRADIOLOGY (CT, MRI, ULTRASOUND,
OTHER), BIOPSY, BLOOD TESTS, OTHER
Radiologist Head of Medical Physics Service
Radiography General Manager Consultant Imaging
Radiographer Specialist Registrars (Senior)
Associate Specialist (Oncology) Consultant
Clinical Scientist in Radiation Protection
Advanced Practitioner Radiography Radiography
Section Manager Advanced Practitioner
Sonographer Laboratory Clinical Co-ordinator
Biomedical Scientist Undertaking Specimen
Dissection Clinical Technologists Reporting
Nuclear Medicine Scans MRI Research Scientist
Specialist Registrar (New Entry) Endoscopy
Practitioner
Radiographer Extended Role Radiography Team
Leader Specialist Radiographer (diagnostic)
Pharmacy Technicians SHO Trainee Endoscopy
Practitioner
Radiographer Practitioner Biomedical Scientists
Assistant Practitioner in Radiography Medical
Secretary Medical Laboratory Assistant
Supervisor Cytology Screener Higher Level
Endoscopy Technician
Senior Clinical Support Worker Medical
Secretary Senior Lab Assistant Specialist
Reception Medical Laboratory Assistant Cutting
Histology Sections Cervical Cytology Screener
Booking Clerk Department Receptionist Clinical
Support Worker Medical Laboratory Assistant
Phlebotomist
Medical Records Clerk Film Archives Nurse
Cadet Domestic Porter Catering Assistant
Medical Laboratory Assistant
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New ways of working Creative possibilities
Development opportunities
Clinical Support Worker
Registered Practitioners
Consultant
Healthcare Scientists develop competency based
roles to meet patient and service demands